Abstract
Staff Physician, Vascular Medicine
Cleveland Clinic Florida
Weston, FL
Tell us about your current vascular medicine practice
I currently practice at Cleveland Clinic Florida. Although this is an academic institution, it runs like a private practice. I see mainly outpatients with all aspects of vascular disease including venous, arterial, and lymphatic. The majority of my clinic patients present with lower extremity edema. I also see unusual vascular diseases, and many patients travel to our center to be evaluated. When needed, I provide hospital consultations, particularly in complex cases.
Vascular medicine has been a part of Cleveland Clinic Florida for many years (more than 20 years!), and it is a well-known department within the institution. Our referrals come from every specialty. We are also well known in our community and have a lot of outside various specialty practice referrals. With the rise in the use of internet-to-research care, we get many self-referrals as well.
We participate in the anticoagulation clinic and diagnostic vascular laboratory. I work in parallel with our vascular surgery colleagues to read arterial and venous duplex ultrasound exams. I have a strong collaboration with the cardiologists, vascular surgeons, and interventional radiologists.
What was your pathway to vascular medicine?
I completed internal medicine training at Baystate Medical Center, an affiliate of Tufts University. When I became interested in cardiovascular disease, my chairman piqued my interest in vascular medicine. I went on to complete a fellowship in vascular medicine at the Cleveland Clinic Main Campus in Ohio and became fascinated with the fact that this is a specialty but requires a good fund of knowledge in general medicine and interplay with other specialties. I eventually became a fellowship program director at Cleveland Clinic in Ohio and enjoyed passing on what I have learned.
How have you been involved in the SVM?
I have been a fellow SVM member for years, and now I am Co-chair of the Diversity, Equity, and Inclusion (DEI) Committee. We are working to promote DEI within the SVM and among our trainees.
From your perspective, what are the benefits of involvement in SVM?
This is a niche specialty where many of us know each other. The benefits include being able to connect easily and access to outstanding material published in this journal. I am proud to be a member of such a bright and outstanding group.
Tell us how you foresee recruiting the next generation of vascular medicine specialists
As more and more people become aware of our specialty, and how we provide quality care to vascular patients, vascular medicine will continue to grow and become more diverse, which leads to more research and innovation. The diversity is important to me given that patients of color are at the highest risk of cardiovascular disease and many times being relatable helps their overall outcome.
Staff Physician, Vascular Medicine
Cleveland Clinic Main Campus
Cleveland, OH
Tell us about your current vascular medicine practice
Currently, my time is split between outpatient practice and inpatient consults. Working at a large tertiary care center, I see a wide variety of patients and disease processes. Much of my work revolves around pulmonary embolism and deep vein thrombosis, as those are my clinical and research interests. I am very active in our Pulmonary Embolism Response Team (PERT) program and quality analysis. In particular, I was lucky to be given the opportunity to start a PERT follow-up clinic, which has been tremendously successful.
What was your pathway to vascular medicine?
My pathway to vascular medicine was quite unique. I actually did not know what vascular medicine was until my second or third year of internal medicine residency at University Hospitals Cleveland Medical Center. Dr Teresa Carman opened my eyes to this amazing field and the rest has been history. After finding out about it, I did an away rotation at Massachusetts General Hospital with Dr Ido Weinberg (where I subsequently did my vascular medicine fellowship training). Following that, I quickly changed my career trajectory and vascular medicine became my focus.
Who has been an influence on your career?
I have been blessed with several great mentors. I would not be where I am if Dr Carman had not introduced me to the field of vascular medicine. Since finding my way into the field, Dr Weinberg has been a tremendous mentor, making sure I have all the resources I need to succeed. Dr Heather Gornik has been fundamental to my early career growth as well. Lastly, Dr Scott Cameron has been an amazing influence, serving as an example of a clinician who can excel both in clinical work and in the research realm. One of the best parts of vascular medicine is that there are numerous titans in the field who are always willing to mentor and guide those early in their career or training.
How have you been involved in the SVM?
Since joining SVM, I have tried to be as active as possible. Whether it be serving in the Next Gen committee to increase awareness of the organization, or live tweeting for the twitter journal clubs. I am also a member of the Diversity, Equity, and Inclusion Committee. The opportunities in SVM are limitless. It has been a highlight of my career thus far. Although there has been a lot of growth within the Society, it is still small enough to feel like you know nearly all the members well. Lastly, the yearly SVM Scientific Sessions are always a favorite; serving on the Scientific Programming Committee is a great experience.
What are the greatest challenges to vascular medicine practice from your viewpoint? What are the greatest benefits?
Recognition. Not just from a specialty perspective, but also in regards to awareness from our co-workers. As I mentioned previously, I was not aware of the field of vascular medicine until my third year of internal medicine residency. Education and awareness at the level of medical school would be greatly beneficial. The more we teach young physicians about vascular medicine, the more the already increasing demand will grow. The opportunity to join a field of medicine with exciting opportunities and the potential for growth is one of vascular medicine’s greatest opportunities.
Past President, Society for Vascular Medicine
Professor of Medicine and Director of Vascular Medicine Section
Zena and Michael A. Wiener Cardiovascular Institute
Icahn School of Medicine at Mount Sinai
New York, NY
Tell us about your current vascular medicine practice
The vascular medicine that I practiced early in my career is nothing like the vascular medicine that makes up most of my practice now. Early on, 75–80% of my practice was made up of common vascular diseases such as peripheral artery disease (PAD), deep vein thrombosis (DVT) and pulmonary embolism, swollen legs, lymphedema, and leg ulcers. However, over the last 15 years there has been a change in the types of vascular diseases that I see. Currently, 75% of my practice involves patients with fibromuscular dysplasia, carotid, vertebral, visceral, and coronary artery dissections, unusual aneurysmal diseases, large vessel vasculitis, and various genetic diseases such as vascular Ehlers–Danlos syndrome. This change in the makeup of my practice is totally driven by patients who become advocates for their own health and do research to find doctors who specialize in these less common diseases.
What was your pathway to vascular medicine?
I took a circuitous route to vascular medicine. I completed 3 years of internal medicine residency at the Cleveland Clinic, followed by a 2-year hypertension and nephrology fellowship. My internal medicine training involved at least 4 months of vascular medicine (3 months inpatient and 1 month outpatient). The Chair of Nephrology at the time was Ray W Gifford, Jr, who also staffed my longitudinal care clinic in hypertension and nephrology. Dr Gifford was not a nephrologist but a world leader in hypertension and one of the early noninvasive vascular medicine specialists from the Mayo Clinic. In addition to hypertension, Dr Gifford wrote papers on PAD, aneurysmal disease, Raynaud’s phenomenon, and Buerger’s disease. After a brief period in Pittsburgh, I was recruited back to Cleveland Clinic to join the section of vascular medicine (then called the department of peripheral vascular diseases) to help develop the renal artery aspect of the program. I never completed a formal vascular medicine fellowship.
Interestingly, my career in vascular medicine happened by chance. Toward the end of my nephrology fellowship, I was planning to move to University of California, Los Angeles as an instructor in medicine and to work in a lab growing glomerular cells with a very well-known nephrologist who specialized in glomerular disease. However, my future mentor decided to move to Salt Lake City prior to my graduation, and at that point I reconsidered my options. This move caused me to abandon my plans to become a basic researcher and focus on clinical medicine and clinical research.
How have you been involved in the SVM?
I have been involved in the SVM since its inception. Shortly after joining the faculty at Cleveland Clinic, 14 people came to Cleveland to begin discussing the formation of the SVM. As soon as it was established, I joined the Society. I was the sixth President for the SVM. This involved a 6-year period of intense involvement in every aspect of the Society (2 years as President-Elect, 2 years as President, and 2 years as immediate Past-President).
From your perspective, what are the benefits of involvement in SVM?
The SVM gives its members the opportunity to interact and be mentored by established leaders in vascular medicine. Likewise, it fosters camaraderie with others with similar interests, which is especially important when you are in a specialty that does not have ABIM certification. It allowed vascular medicine specialists to find each other and, at least early on, everyone knew each other. Close friendships formed and research collaboration occurred among the members. The meetings are always great educational experiences and socially enjoyable. I have close friends going on 30 years, and the Society helped foster these friendships.
I cannot imagine being involved in vascular medicine without being involved in the SVM.
Tell us how you foresee recruiting the next generation of vascular medicine specialists
This has been of great interest to me for a long time. In my presidential address at the SVM Scientific Sessions in 2000 and 2001, I discussed my evolving thought process from considering vascular medicine survival as a stand-alone specialty to thinking our only option for survival is as a subspecialty of cardiology.1,2 It is important to note that there are many talented people in our society who did not do a cardiology fellowship and, thus, this model would have excluded them from fellowship training in vascular medicine, myself included.
Unfortunately, there are not enough people that want to pursue vascular medicine directly from internal medicine, and the internist pathway does limit those that subsequently hope to pursue vascular intervention without cardiology training. On the flip-side, recruitment of talented providers from cardiology has been a challenge because many cardiology graduates are focused on intervention, heart failure, or other subspecialties.
Recruiting the next generation remains a challenge for our specialty, and I do not have a solution. I look to the early and mid-career vascular medicine specialists to find the solution!